Child neglect is the dominant problem in the child welfare system, accounting for over 64% of cases annually. Neglect is also the most serious form of maltreatment, leading to an array of negative outcome that are biological, social, emotional, and behavioral in nature. The SafeCare(R) model is one of the few evidenced-based practices that focus on child neglect by teaching parents skills that address proximal antecedents of neglect (safety, health, and parent- child interactions). The National SafeCare Training and Research Center conducts training and research on the SafeCare model. To achieve optimal implementation, practitioners conducted SafeCare (or any new practice) must be "coached" live as the implement a practice. The proposed study will examine three different models of coaching, one in which NSTRC coaches providers directly (purveyor coaching), and the other two in coaching is conducted by the local implementation team and supported either by the NSTRC, or by an intermediary organization whose staff has become certified SafeCare trainers. Thus we will examine how implementation is affected by coaching when the purveyor group (NSTRC) is a various levels of closeness to the actual implementation. We will randomly assign 90 providers at 30 agencies to receive one of the three forms of coaching, and will examine implementation related variables (provider fidelity and competence, and family skill acquisition) as the primary outcomes. We will also conduct a rigorous cost effectiveness analysis of the coaching models to understand costs with respect to return on fidelity. PUBLIC HEALTH RELEVANCE: The prevention of child maltreatment and child neglect in particular is a public health priority. Neglect leads to a range of negative health outcomes, and receives little attention relative to other forms of child maltreatment. The SafeCare model is a behaviorally-based parent-training program (SafeCare) that targets skill deficits that can lead to neglect. The proposed study will examine how three models of coaching home visitors to implement SafeCare affect program delivery. This study will provide information about how best to conduct coaching in an effective and efficient manner so that the evidenced-based program, SafeCare, can be disseminated as broadly as possible given limited resources.